EP1265601A2 - Behandlung von augenschmerzen - Google Patents
Behandlung von augenschmerzenInfo
- Publication number
- EP1265601A2 EP1265601A2 EP01910734A EP01910734A EP1265601A2 EP 1265601 A2 EP1265601 A2 EP 1265601A2 EP 01910734 A EP01910734 A EP 01910734A EP 01910734 A EP01910734 A EP 01910734A EP 1265601 A2 EP1265601 A2 EP 1265601A2
- Authority
- EP
- European Patent Office
- Prior art keywords
- pain
- brimonidine
- eye
- ocular
- response
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
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- 239000003401 opiate antagonist Substances 0.000 description 1
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- 210000001328 optic nerve Anatomy 0.000 description 1
- 239000003960 organic solvent Substances 0.000 description 1
- 230000037324 pain perception Effects 0.000 description 1
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- 239000008194 pharmaceutical composition Substances 0.000 description 1
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- 229940096826 phenylmercuric acetate Drugs 0.000 description 1
- PDTFCHSETJBPTR-UHFFFAOYSA-N phenylmercuric nitrate Chemical compound [O-][N+](=O)O[Hg]C1=CC=CC=C1 PDTFCHSETJBPTR-UHFFFAOYSA-N 0.000 description 1
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- RUOJZAUFBMNUDX-UHFFFAOYSA-N propylene carbonate Chemical compound CC1COC(=O)O1 RUOJZAUFBMNUDX-UHFFFAOYSA-N 0.000 description 1
- XEYBRNLFEZDVAW-UHFFFAOYSA-N prostaglandin E2 Natural products CCCCCC(O)C=CC1C(O)CC(=O)C1CC=CCCCC(O)=O XEYBRNLFEZDVAW-UHFFFAOYSA-N 0.000 description 1
- 229940127293 prostanoid Drugs 0.000 description 1
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- HNJBEVLQSNELDL-UHFFFAOYSA-N pyrrolidin-2-one Chemical compound O=C1CCCN1 HNJBEVLQSNELDL-UHFFFAOYSA-N 0.000 description 1
- 150000003873 salicylate salts Chemical class 0.000 description 1
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- HRZFUMHJMZEROT-UHFFFAOYSA-L sodium disulfite Chemical compound [Na+].[Na+].[O-]S(=O)S([O-])(=O)=O HRZFUMHJMZEROT-UHFFFAOYSA-L 0.000 description 1
- 229940001584 sodium metabisulfite Drugs 0.000 description 1
- 235000010262 sodium metabisulphite Nutrition 0.000 description 1
- AKHNMLFCWUSKQB-UHFFFAOYSA-L sodium thiosulfate Chemical compound [Na+].[Na+].[O-]S([O-])(=O)=S AKHNMLFCWUSKQB-UHFFFAOYSA-L 0.000 description 1
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
- A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P27/00—Drugs for disorders of the senses
- A61P27/02—Ophthalmic agents
Definitions
- This invention relates to the topical application of brimonidine for treating ocular pain and neurogenic inflammation and compositions useful for such application.
- Pain is a well known phenomenon as an indicator of injury or tissue damage due to inflammation, ischemia, mechanical or other irritation.
- the first step leading to the sensation of pain is the activation of nociceptive primary afferents by intense thermal, mechanical or chemical stimuli.
- nociceptive transduction activation
- chemical mediators include lactic acid, hypertonic saline, histamine, 5- hydroxytryptamine, potassium chloride, acetylcholine, purines, bradykinin and substance P which are referred to as algesic agents.
- prostaglandins and leukotrienes can contribute to the activation of primary afferent nociceptors.
- Prostaglandins are uniquely distinguished from the other chemical mediators in that they induce a state of hyperalgesia by elevating the sensitivity of pain receptors to other painful or algesic stimuli.
- neuropeptides (substance P, calcitonin gene-related peptide, neurokinin A) at their peripheral terminals. Neuropeptides enhance inflammatory reactions in the injured tissue, contributing to vasodilation, edema, and increased vascular permeability; this phenomenon is called 'neurogenic inflammation'.
- the nociceptors enter the gray matter of the superficial dorsal horn to synapse on nerve cells contributing to pain-transmission pathways such as the spinothalamic and spinoreticulothalamic tracts which terminate in two separate regions in the thalamus.
- the two thalamic regions in turn project to different cortical sites.
- the pain transmitting and modulating system depicted so far depends on numerous chemical moieties for its integrated function.
- Anesthetics block neuronal transmission and affect sensation as well as pain.
- Analgesics act by interfering with the activity of chemical mediators of nociception without affecting sensory input.
- analgesics can be classified as falling into at least three loose groups: 1) the opiate-based (narcotic) analgesics; 2) the non-opiate analgesics; and 3) analgesics and antipyretics.
- the opiate-based analgesics include opium derived alkaloids, including morphine, codeine, and their various derivatives, opiate antagonists, the several morphine derivatives which have morphine antagonist activity, but have analgesic activity.
- analgesics and antipyretics are the salicylates and acetamide-containing compounds and the so-called non-steroidal anti- inflammatory drugs. They are non-addictive pain killers.
- drugs that block perception of pain may be said to act either centrally (such as narcotics) or peripherally.
- NSAIAs non-steroidal anti-inflammatory agents
- NSAIAs as pain relievers is associated with the biosynthesis of prostanoids.
- PGE2 prostaglandin E2
- Inhibitors of prostaglandin synthesis act by avoiding the sensitizing effects of prostaglandins on nociceptive endings and therefore, the decrease in pain threshold.
- Ophthalmic applications of various NSAIAs are also known, including the utilization of their anti-inflammatory properties for control of various ocular inflammations.
- NSAIAs have been used for the treatment of non-inflammatory, localized pain, such as non-inflammatory ocular pain.
- Calcium channel blockers have been suggested as useful for treating pain, including ocular pain.
- the present invention is based on the unexpected finding that brimonidine efficiently relieves ocular pain, including ocular pain associated with comeal injuries.
- a topical composition including brimonidine
- brimonidine for the relief of eye pain offers several benefits over the use of systemic agents because of the decreased systemic absorption, which may decrease side-effects, and increased ocular absorption that can increase efficacy.
- Alpha-2 agonists including brimonidine have been shown to alleviate systemic pain in animal models, including hot plate, tail flick and nerve ligation.
- One alpha- 2 agonist, clonidine is administered epidurally for treating chronic pain in humans. The sites of action are presumed to be in the spinal cord and in the brain, where they can reduce the perception of pain.
- One potential mechanism for the alleviation of pain at the level of the spinal cord is the inhibition of release of the chemical mediators of pain, including substance P and calcitonin gene-related peptide. This mechanism has been demonstrated in vitro for the alpha-2 agonist, dexmedetomidine, acting on rat spinal cord slices (M. Takano, Y. Takano and T.
- the present invention relates to a method for treating ocular pain in a mammal afflicted by such pain, which method comprises applying to the eye of said mammal an effective amount of brimonidine in a pharmaceutically acceptable vehicle.
- the Figure shows a recording of the rabbit eye response to 0.5M NaCl, alone, and in the presence of brimonidine.
- An effective dose when it comes to topical, ocular pain, is a matter of broad therapeutically effective dose requirements. This figure is one controlled by a number of factors: the inherent activity of the drug itself; the vehicle in which it is administered, primarily topical delivery being anticipated; the size of the area to be treated; and the intensity of the pain. Exact dosing data have not been determined but it is anticipated that a topical formulation having between 0.01% and 0.5% (weight/volume) of a brimonidine will provide relief from ocular pain. The determination of the effective dose for any selected compound is well within the skill of an ordinary skilled physician.
- brimonidine may be administered in any manner which will deliver the drug directly to the locale of the pain to be treated. It is anticipated that this will be by application to the immediate area of distress.
- the drug could be applied topically, or by some similar means which delivers the drug directly to the affected area. It is not intended that this invention be practiced by administering the drug in such a way as to insure that it gets to the central nervous system. In fact, that would defeat the whole purpose of this invention which is focused on treating the pain at its source.
- solutions are prepared typically containing from about 0.01% to about 0.5% of active ingredient, and a physiological saline solution as a major vehicle.
- the pH of such ophthalmic solutions should preferably be maintained between 6.5 and 7.2 with an appropriate buffer system.
- the formulations may also contain conventional, pharmaceutically acceptable preservatives, stabilizers and/or penetration enhancers.
- the preferred vehicle that may be used in the ophthalmic solutions of the present invention is purified water, more preferably a physiological saline solution. Additional suitable vehicles include but are not restricted to, viscosity agents such as polyvinyl alcohol, povidone, hydroxypropyl methyl cellulose, poloxamers, carboxymethyl cellulose, carbomer and hydroxyethyl cellulose.
- Preferred preservatives that may be used in the ophthalmic formulations of the present invention include, but are not limited to, benzalkonium chloride, chlorobutanol, thimerosal, phenylmercuric acetate and phenylmercuric nitrate.
- Penetration enhancers may, for example, be surface active agents; certain organic solvents, such as dimethylsulfoxide and other sulfoxides, dimethylacetamide and pyrrolidone; certain amides of heterocyclic amines, glycols (e.g., propylene glycol); propylene carbonate; oleic acid; alkyl amines and derivatives; various cationic, anionic, nonionic, and amphoteric surface active agents; and the like.
- organic solvents such as dimethylsulfoxide and other sulfoxides, dimethylacetamide and pyrrolidone
- certain amides of heterocyclic amines such as dimethylsulfoxide and other sulfoxides, dimethylacetamide and pyrrolidone
- certain amides of heterocyclic amines such as glycols (e.g., propylene glycol); propylene carbonate
- oleic acid e.g., propylene glycol
- Tonicity adjustors may be added as needed or convenient. They include, but are not limited to, salts, particularly sodium chloride, potassium chloride, mannitol and glycerin, or any other suitable opthalmically acceptable tonicity adjustor.
- buffers include acetate buffers, citrate buffers, phosphate buffers and borate buffers for ophthalmic use.
- an ophthalmically acceptable antioxidant for use in the present invention includes, but is not limited to, sodium metabisulfite, sodium thiosulfate, acetylcysteine, butylated hydroxyanisole and butylated hydroxytoluene.
- excipient components which may be included in the ophthalmic preparations are chelating agents.
- the preferred chelating agent is edetate disodium, although other chelating agents may also be used in place or in conjunction with it.
- a clinical study is performed to compare the analgesic effect of topically administered brimonidine and placebo following radial keratotomy surgery.
- One hundred and twenty-four male and female subjects, 21 to 45 years of age, undergo routine, elective, unilateral radial keratotomy for the correction of myopia and brimonidine is administered as a 0.03% ophthalmic solution.
- Each subject receives one drop of the assigned study medication every four hours while awake one day prior to surgery and again every 20 minutes for the two hours just before surgery. Each subject then undergoes unilateral radial keratotomy.
- each subject receives one drop of the study medication in the operated eye every four hours while awake for 14 consecutive days. Postoperative examinations occur at days 1, 3, 7 and 14.
- Efficacy is assessed by evaluation of pain intensity, pain relief, subjective global analgesic efficacy. Symptoms of ocular inflammation (burning stinging, tearing, etc.) are also recorded.
- Brimonidine is prescribed as a sole treatment of pain. On instillation of the medication, the patient reports relief of pain for approximately two and a half hours. Upon recurrence of pain, a second dose of brimonidine provides pain relief.
- a 32 year old female patient with a history of gas-permeable contact lens wear has a two-to-three day history of pain in her left eye.
- the patient is treated with brimonidine for pain.
- the patient reports relief of pain for two hours.
- the effect of brimonidine on ocular pain is also studied using the Corneal Nerve Conduction Model.
- This model is performed in rabbits as a way to determine the types and quantity of nerve traffic generated as the cornea is exposed to various stimuli.
- a rabbit under deep anesthesia is placed in a stereotaxic apparatus.
- the retro-orbital space is surgically exposed and a hook electrode is placed around the ciliary nerve that sits adjacent to the optic nerve.
- the ocular surface is fitted with a chamber through the use of a conjunctival pharyngeal ring into which test formulations can be added.
- a dose range of an ophthalmic formulation of brimonidine (0.01% to 0.5% for instance) as well as a vehicle is filled into the chamber and the resultant nerve traffic from the cornea is recorded. In this way the effects of brimonidine on ocular surface sensation is determined.
- This study is also performed in the presence of an ocular surface sensory challenge such as topical capsaicin, potassium chloride or fine hairs.
- Ocular responses characteristic of neurogenic inflammation are also observed in rabbits following external stimuli.
- the ability of an ophthalmic solution of brimonidine at concentrations ranging from 0.01% to 0.5% to reduce the neurogenic response at 5, 10, 15, 30 and 60 minutes following administration is determined.
- Brimonidine is effective in reducing such neurogenic responses.
- the rabbit neurophysiological model is a predictor of actions on the corneal nerves that are associated with the sensation of corneal irritation and pain in humans.
- this experiment is carried out in the anesthetized rabbit and enables one to make decisions as to the effect on the human eye.
- the corneal nerves are activated in the rabbit model-pain would be sensed in the human.
- the amount of neural activity is decreased the amount of pain or sensory irritation in the human would decrease.
- the rabbit neurophysiological model one records from the primary sensory axons so the results reflect what is occurring at the sensory receptor in the corneal epithelium.
- the Figure shows a response at the top, a control response to mechanical stimulation, this is carried out to ensure that the preparation is lively.
- Test solutions are put into a chamber, about 1 cc, over the surface of the cornea. The test solution is blocked from reaching the axons where the recording is made.
- Application of a standard stimulus, 0.5M NaCl for 30 seconds elicits rapid action potential activity which lasts beyond the end of the stimulus.
- the NaCl is washed away by several applications of saline.
- Brimonidine as Allergan, Inc.'s Alphagan® pharmaceutical composition, was put into the chamber for 1 minute, and not washed before retesting with the 0.5M NaCl.
- brimonidine may be useful to decrease corneal sensory irritation and pain.
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- Health & Medical Sciences (AREA)
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- General Health & Medical Sciences (AREA)
- Animal Behavior & Ethology (AREA)
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- Public Health (AREA)
- Chemical & Material Sciences (AREA)
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- Chemical Kinetics & Catalysis (AREA)
- Bioinformatics & Cheminformatics (AREA)
- Engineering & Computer Science (AREA)
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- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Ophthalmology & Optometry (AREA)
- General Chemical & Material Sciences (AREA)
- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
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US182609P | 2000-02-15 | ||
PCT/US2001/004851 WO2001060347A2 (en) | 2000-02-15 | 2001-02-15 | Method for treating ocular pain |
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EP1265601A2 true EP1265601A2 (de) | 2002-12-18 |
EP1265601B1 EP1265601B1 (de) | 2003-11-19 |
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EP (1) | EP1265601B1 (de) |
JP (1) | JP4970685B2 (de) |
AT (1) | ATE254461T1 (de) |
AU (2) | AU2001238313C1 (de) |
CA (1) | CA2400377C (de) |
DE (1) | DE60101265T2 (de) |
HK (1) | HK1051499A1 (de) |
WO (1) | WO2001060347A2 (de) |
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US20040266776A1 (en) * | 2003-06-25 | 2004-12-30 | Gil Daniel W. | Methods of preventing and reducing the severity of stress-associated conditions |
US7439241B2 (en) * | 2003-05-27 | 2008-10-21 | Galderma Laboratories, Inc. | Compounds, formulations, and methods for treating or preventing rosacea |
US8410102B2 (en) * | 2003-05-27 | 2013-04-02 | Galderma Laboratories Inc. | Methods and compositions for treating or preventing erythema |
US20050058696A1 (en) * | 2003-09-12 | 2005-03-17 | Allergan, Inc. | Methods and compositions for the treatment of pain and other alpha 2 adrenergic-mediated conditions |
US20080261893A1 (en) * | 2006-02-24 | 2008-10-23 | Denise Barbut | Topical corneal analgesia using neurotensin receptor agonists and synergistic neurotensin combinations without delaying wound healing |
CA2680704A1 (en) * | 2007-03-12 | 2008-09-18 | Sarentis Therapeutics, Inc. | Topical corneal analgesia using neurotensin receptor agonists and synergistic neurotensin combinations without delaying wound healing |
US20080317819A1 (en) * | 2007-06-21 | 2008-12-25 | Orilla Werhner C | Iop lowering drug combination or non-combination loaded contact lens with zonal drug delivery areas |
US20090004244A1 (en) * | 2007-06-27 | 2009-01-01 | Orilla Werhner C | Iris design as a drug depot for zonal drug delivery by contact lens |
US20090004245A1 (en) * | 2007-06-28 | 2009-01-01 | Orilla Werhner C | Use of an iris simulated layer to allow aesthetic appearance drug loaded contact lens |
US20090061020A1 (en) * | 2007-08-31 | 2009-03-05 | Theobald Klaus P | Brimonidine Compositions for Treating Erythema |
US20100227868A1 (en) * | 2007-09-20 | 2010-09-09 | Johnson Brent A | Treatment methods with brimonidine |
BRPI0822095A2 (pt) * | 2007-12-21 | 2014-10-07 | Galderma Lab Inc | Método para reduzir o sangramento e/ou hematoma em um paciente |
PL3031825T3 (pl) | 2008-03-14 | 2020-02-28 | Allergan, Inc. | Immunologiczne oznaczenie aktywności toksyny botulinowej serotypu a |
KR101604515B1 (ko) | 2008-03-14 | 2016-03-17 | 알러간, 인코포레이티드 | 면역-기반 보툴리눔 독소 세로타입 a 활성 검정 |
US8080550B2 (en) * | 2008-08-01 | 2011-12-20 | Alpha Synergy Development, Inc. | Anesthetic compositions and methods of use |
US20180369240A1 (en) * | 2008-08-01 | 2018-12-27 | Eye Therapies Llc | Preferential Vasoconstriction Compositions and Methods of Use |
US20180360825A1 (en) * | 2008-08-01 | 2018-12-20 | Eye Therapies, Llc | Vasoconstriction compositions and methods of use |
US20100203165A1 (en) * | 2008-08-01 | 2010-08-12 | Gerald Horn | Compositions and methods for treatment of disorders or conditions of the eye |
US8299079B2 (en) | 2009-05-22 | 2012-10-30 | Kaufman Herbert E | Preparations and methods for ameliorating or reducing presbyopia |
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US8394800B2 (en) | 2009-11-19 | 2013-03-12 | Galderma Laboratories, L.P. | Method for treating psoriasis |
BR112012024476A2 (pt) | 2010-03-26 | 2017-03-01 | Galderma Res & Dev | método para fornecer um tratamento seguro e efetivo da telangiectasia e método de produzir um produto embalado |
KR20150055082A (ko) | 2010-03-26 | 2015-05-20 | 갈데르마 리써어치 앤드 디벨로프먼트 | 홍반의 유효하고 안전한 치료를 위한 개선된 방법 및 조성물 |
US10413506B2 (en) | 2010-04-03 | 2019-09-17 | Praful Doshi | Medical devices including medicaments and methods of making and using same including enhancing comfort, enhancing drug penetration, and treatment of myopia |
ES2634551T3 (es) | 2010-04-03 | 2017-09-28 | Praful Doshi | Métodos para revestir una lente de contacto |
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2003
- 2003-05-27 HK HK03103773A patent/HK1051499A1/xx not_active IP Right Cessation
Non-Patent Citations (1)
Title |
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See references of WO0160347A2 * |
Also Published As
Publication number | Publication date |
---|---|
DE60101265D1 (de) | 2003-12-24 |
CA2400377A1 (en) | 2001-08-23 |
WO2001060347A3 (en) | 2002-02-28 |
JP2003522785A (ja) | 2003-07-29 |
AU2001238313C1 (en) | 2004-11-04 |
AU2001238313B2 (en) | 2004-05-27 |
EP1265601B1 (de) | 2003-11-19 |
AU3831301A (en) | 2001-08-27 |
CA2400377C (en) | 2007-11-27 |
DE60101265T2 (de) | 2004-08-26 |
JP4970685B2 (ja) | 2012-07-11 |
US6294553B1 (en) | 2001-09-25 |
ATE254461T1 (de) | 2003-12-15 |
US20010031754A1 (en) | 2001-10-18 |
WO2001060347A2 (en) | 2001-08-23 |
HK1051499A1 (en) | 2003-08-08 |
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